MEDICARE: S W MABEE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386697373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S W MABEE LLC

Provider Business Mailing Address
First Line	:	PO BOX 26010
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44319-6010
Country	:	US
Telephone Number	:	888-719-9015
Fax Number	:

Provider Business Practice Location Address
First Line	:	3624 W MARKET ST
Second Line	:	STE 103
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-4510
Country	:	US
Telephone Number	:	330-665-9800
Fax Number	:

Authorized Official
Title or Position	:	CLIENT REPRESENTATIVE
Name	:	SAGE YARBROUGH
Credential	:
Telephone Number	:	330-493-9004

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	11/19/2007

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